Healthcare Provider Details

I. General information

NPI: 1518025535
Provider Name (Legal Business Name): JOHN CHARLES BLAUSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANTA BARBARA COTTAGE HOSPITAL PUEBLO AT BATH
SANTA BARBARA CA
93102
US

IV. Provider business mailing address

PO BOX 5007
SAN LUIS OBISPO CA
93403-5007
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-7367
  • Fax: 805-569-8354
Mailing address:
  • Phone: 805-710-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberG654820
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG654820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: